Globalization in the health sector has led to increased interest in identifying and articulating global bioethical frameworks to guide health practices. The ‘Universal Declaration on Bioethics and Human Rights’ (UDBHR) attempts to balance cultural diversity while promoting universal principles. This chapter discusses two key political issues: the legitimacy of this declaration and the universality of its application. It defines key terms to assess the legitimacy and coherence of the UDBHR, providing a brief history and describing how it fits with other international efforts to outline ethical principles and procedures for clinical research and healthcare, then discusses in depth the political questions of the UDBHR’s universality in the context of cultural diversity and UNESCO’s legitimacy in advancing it. Finally, the chapter notes that the UDBHR’s legitimacy would be further enhanced through local iterations that appeal to diverse regional, cultural, and ethnic traditions.